The Management Strategy of Renal Angiomyolipoma

腎臟血管肌肉脂肪瘤的治療策略

蔡秀男(Hsiu-Nan Tsai) ； 周以和(Yii-Her Chou) ； 沈榮宗(Jung-Tsung Shen) ； 黃書彬(Shu-Pin Huang) ； 吳文正(Wen-Jeng Wu) ； 王起杰(Chii-Jye Wang) ； 黃俊雄(Chun-Hsiung Huang)

《The Kaohsiung Journal of Medical Sciences》 18卷7期 (2002/07) Pp. 340-346

https://doi.org/10.6452/KJMS.200207.0340

摘要

本文將研究腎臟血管肌肉脂肪瘤的臨床特性，並分析其治療策略。回顧本院自民國79年至民國91年來的病歷記載，我們收集了總共62位患者，其中有44位女性(71%)，18位男性，平均年齡46.9歲。其中8位雙側腎臟血管肌肉脂肪瘤中，有4位(50%)患者是結節性硬化症。四位結節性硬化症患者皆有雙側腎臟血管肌肉脂肪瘤(100%)。34位(54.8%)患者是沒有症狀的。產生自發性腎臟破裂的有9位(14.5%)。平均腫瘤大小為4.83公分。腫瘤大於4公分者有明顯症狀(60.7%)，也有較高的腎切除率(43%)。治療策略是根據腫瘤大小以及臨床表徵而定。有30位接受保守觀察治療，有2位接受血管栓塞治療以控制出血，有14位接受腎臟部分切除及其他腎臟保存手術，有16位接受腎臟全切除(25.8%)。此外，9位產生自發性腎臟破裂的患者中，有3位接受保守觀察治療，有1位接受血管栓塞治療，有1位接受腎臟部分切除，有3位接受全腎臟切除，有1位接受部腹探查止血手術。手術後恢復良好並沒有重大併發症或死亡。治療策略上，我們建議對於懷疑惡性腫瘤者進行全腎臟切除，對於四公分以下無症狀的腫瘤可以採取保守觀察治療，對於腎臟出血及自發性腎臟破裂，可先採行動脈血管栓塞緊急處置，此外，應盡量採行腎臟部分切除等保守性手術，以保留腎臟功能。

並列摘要

The purpose of this study is to analyze the management strategy of renal angiomyolipoma . From 1990 to 2002, a total of 62 patients with renal
angiomyolipoma were treated at our medical center. Angiomyolipomas were found in 44 female patients (71.0%) and 18 male patients. Of these patients the age ranged from 18 to 87 y/o (mean: 46.9y/o). Four of 8 patients with bilateral angiomyolipomas were associated with tuberous sclerosis (TS). Nine (14.5%) of 62 patient had got spontaneous rupture. However, 54.8 per cent of patients were asymptomatic. The . mean tumor size was 4.83 cm. Tumors larger than 4 cm had a greater incidence of symptoms (60.7%) and a higher nephrectomy rate (43%). Clinical managementwas based on tumor size and clinical presentation. Treatment consisted of conservative observation in 30 patients (group 1, 48.4%), selective embolization therapy in 2 patients with hemorrhage (group 2, 3.2%), partial nephrectomy and other surgical procedures in 14 patients (group 3, 22.6%), and total nephrectomy in 16 patients (group 4, 25.8%). Nine of 62 patients were associated with spontaneous angiomyolipoma rupture under conservative treatment in 3, TAE in 1, partial nephrectomy in 1, total nephrectomy in 3 and laparotomy to check bleeding in 1. Neither mortality nor major complication was noted. Generally the outcomes were smooth and acceptable. Beyond the total nephrectomy for patients with highly suspected malignancy, we suggest conservative treatment with observation strategy for small asymptomatic tumors, selective arterial embolization as the first choice for hemorrhage or rupture and partial nephrectomy for renal sparing strategy.

並列關鍵字

renal angiomyolipoma ； tuberous sclerosis ； arterial embolization ； spontaneous rupture