Diagnosis and Surgical Management of Renal Angiomyolipoma: Clinical Experience at Taipei Veterans General Hospital

腎臟血管肌脂肪瘤之診斷以及外科處置：台北榮總臨床經驗

蔡昇翰(Sheng-Han Tsai) ； 盧星華(Shing-Hwa Lu) ； 陳光國(Kuang-Kuo Chen) ； 林登龍(Alex T. L. Lin) ； 張延驊(Yen-Hwa Chang) ； 張心湜(Luke S. Chang)

《臺灣泌尿科醫學會雜誌》 16卷3期 (2005/09) Pp. 108-114

摘要

研究目的：保留腎臟功能是處理腎臟血管肌脂肪瘤相當重要的課題。我們回溯性地分析台北榮總處理腎臟血管肌脂肪瘤的臨床經驗。
材料與方法：一九九五年一月份至二○○三年一月份，共有三十九位腎臟血管肌脂肪瘤病患於本院確定診斷；他們接受腹部超音波、電腦斷層掃描、或核磁共振影像檢查初步診斷並決定開刀之術式。我們回溯性地研究這群病患的病歷、影像學檢查、以及病理報告以評估影像學診斷腎臟血管肌脂肪瘤之準確性。
研究結果：腎血管肌脂肪瘤多爲機緣性發現，最常見的臨床症狀是腰痛，其次依序是腹痛及血尿。三十九位病人中十四位術前影像診斷爲腎細胞癌，一位爲腎旁惡性脂肪瘤，剩餘二十四位腎血管肌脂肪瘤。影像學診斷的敏感度是百分之六十一點五。七位病患合併腫瘤自主性出血，只有一位接受腎保留手術。本研究中共計十六位病患接受全腎切除手術，其中一位因爲腫瘤大量出血接受兩側全腎切除，十六位病患接受部分腎切除手術，七位病患接受腫瘤切除術。三位病患術前診斷爲腎細胞癌因爲術中冰凍切片報告是血管肌脂肪瘤而接受腎臟保留的手術方式。
結論：單靠影像學診斷腎臟血管肌脂肪瘤敏感度不高。特別是某些腎臟血管肌脂肪瘤所含脂肪成分太少增加診斷的難度。基於術前影像學檢查所計畫的術式可能會造成過當的腎臟切除。術中冰凍切片檢查提供了組織上的診斷，可以降低過當的全腎切除手術。

關鍵字

腎臟血管肌脂肪瘤 ； 腎細胞癌

並列摘要

OBJECTIVE: Preserving renal function is a significant concern in dealing with renal angiomyolipomas. We conducted this retrospective study to analyze the clinical management of renal angiomyolipomas at Taipei Veterans General Hospital.
MATERIALS AND METHODS: From January 1995 to January 2003, 39 patients were diagnosed with renal angiomyolipomas by pathology in our institution. Abdomen ultrasonography, computed tomography and magnetic resonance imaging were used as the preoperative diagnostic tools. The medical records, imaging studies, and pathological results of these patients were retrospectively reviewed.
RESULTS: In our series, most angiomyolipomas were diagnosed incidentally (64.1%), and the most-common symptom was ipsilateral flank pain (20.5%), followed by abdominal pain (12.8%) and hematuria (10.3%). Of the 39 patients, 14 were diagnosed as having renal cell carcinoma preoperatively, 1 as having perinephric liposarcoma, and the remaining 24 as having an angiomyolipoma. Low sensitivity (61.5%) in the imaging studies was noted in our series. Spontaneous hemorrhage was noted in 7 patients (17.0%), and only 1 received nephron-sparing surgery. In our series, 16 patients received a nephrectomy, including 1 who undeiwent bilateral nephrectomies, 16 received a partial nephrectomy, and 7 underwent tumor enucleation. Three patients with a preoperative impression of renal cell carcinoma received nephron-sparing surgery because of intraoperative frozen section which revealed the angiomyolipoma.
CONCLUSIONS: Low sensitivity in imaging studies makes the preoperative diagnosis for renal angiomyolipomas more difficult especially for tumors with a lower fat content. Surgical design based on the preoperative imaging studies may lead to unnecessary nephrectomies. Intraoperative frozen section provides histopathological confirmation and may prevent an unnecessary nephrectomy.

並列關鍵字

angiomyolipoma ； renal cell carcinoma