巨大肾血管平滑肌脂肪瘤的多层螺旋CT特征及临床联系  

MSCT features of giant renal angiomyolipoma and its relation to clinical features

作　　者：许连光 朱永东 李辉 罗良平[2] XU Lianguang;ZHU Yongdong;LI Hui;LUO Liangping(Medical Imaging Center ,Dangguan Nancheng Hospital,Dongguan 523071,China;Medical Imaging Center,the First Affiliated Hospital of Jinan University ,Guangzhou 510630,China)

机构地区：[1]东莞市南城医院医学影像中心,广东东莞523071 [2]暨南大学附属第一医院医学影像中心,广东广州510630

出　　处：《实用放射学杂志》2019年第8期1286-1289,共4页Journal of Practical Radiology

摘　　要：目的探讨巨大肾血管平滑肌脂肪瘤(RAML)的MSCT征象和手术治疗方式选择的影像学依据。方法收集经手术病理证实的17例巨大RAML患者的临床和MSCT资料,回顾性分析肿瘤的MSCT征象及汇总手术治疗方式。结果 MSCT征象:外生型 11例(65%),肾内型6 例(35%),富含脂肪15 例(88%),乏脂肪2 例(12%),突出肾轮廓外并肾皮质缺损14例(82%),瘤内可见迂曲扩张血管影15例(88%),合并出血5 例(29%),肿瘤血管延伸至肾实质15例(88%),肾脏位移9例(52%)。17例均行手术治疗,其中开放性手术8例(47%),包括保留肾单位手术5例(30%),肾切除术2例(12%)及术前误诊为肾癌而行肾癌根治术1例(5%);腹腔镜保留肾单位手术 9例(53%)。结论巨大RAML具有一定的特征性MSCT征象,即脂肪密度、瘤内迂曲增粗的血管影、瘤内和(或)周围出血、瘤内血管穿过肾实质走行及瘤与肾脏交界面的肾皮质缺损。MSCT检查有助于治疗前的准确诊断,并能三维显示肿瘤及血管的解剖。Objective To explore the MSCT features of giant renal angiomyolipoma and determain the imaging evidences for selection of suitable surgical methods. Methods The clinical and MSCT data of 17 patients with giant renal angiomyolipoma confirmed by surgery and pathology were collected.MSCT features of the tumor were analyzed retrospectively, and the surgical methods were summarized. Results The MSCT showed the tumours with exophytic type in 11 cases (65%), endogenetic type in 6 cases (35%), abundant intratumoral fat in 15 cases (88%), lack of intratumoral fat in 2 cases (12%), protruding extrarenal contour with renal parenchymal defect in 14 cases (82%), tortuous and dilated intratumoral vessels in 15 cases (88%) intratumoral hemorrhage in 5 cases (29%), tumoral vessels extending into the rennal parenchyma in 15 cases (88%) and kidney displacement in 9 cases (52%).Of the 17 cases,8 cases (47%) underwent open surgical operation, including nephron-sparing surgery in 5 cases (30%), nephrectomy in 2 cases (12%) and radical nephrectomy due to a misdiagnosis as renal carcinoma before operation in 1 case (5%).9 cases (53%) underwent laparoscopic nephron sparing surgery.Gmdusion The characteristic MSCT features,of giant renal angiomyolipoma are intratumoral fat, tortuous and dilated intratumoral vessels,intratumora hemorrhage,tumoral vessels extending into the rennal parenchyma and renal parenchymal defect at the junction between tumor and kideny.MSCT will help to make an accurate diagnosis before treatment,and can display the 3D stucture of tumor and blood vessels.

关 键 词：肾肿瘤 肾血管平滑肌脂肪瘤 计算机体层成像 

分 类 号：R737.11[医药卫生—肿瘤] R814.42[医药卫生—临床医学]