不同手术入路治疗肾错构瘤破裂出血的回顾性分析  

Retrospective analysis of different operative approach in surgical treatment of renal angiomyolipoma complicated with bleeding from spontaneous rupture

作　　者：张源锋[1] 陈少川 林伟强[1] 林嘉华[1] 徐庆春[1] 张永海[1] ZHANG Yuan-feng(Department of urology,the Shantou central hospital(the affiliated hospital of Sun Yatsen university),Shantou,Guangdong,515031,China)

机构地区：[1]汕头市中心医院(中山大学附属汕头医院)泌尿外科,广东汕头515031

出　　处：《齐齐哈尔医学院学报》2020年第3期302-304,共3页Journal of Qiqihar Medical University

基　　金：汕头市科技计划项目(汕府科[2017]119号-13)。

摘　　要：目的探讨不同的手术入路治疗肾错构瘤破裂出血,更快速完整地切除肿瘤,保护肾功能,减少并发症。方法回顾性总结2010年5月-2018年6月本院收治的因肾错构瘤破裂出血进行手术治疗的患者31例,统计并分析手术病例的肿瘤最大直径、手术入路、出血量、手术时间等观察指标。结果所有病例均成功抢救。手术入路的选择上,经腹部入路和经腹膜后入路两种手术入路与肿瘤直径之间差异有统计学意义(P<0.05)。两组手术入路在手术时间、术中出血的比较,差异有统计学意义(P<0.05)。两组手术入路在肿瘤位置、热缺血时间、术前后血肌酐的变化等差异无统计学意义(P>0.05)。所有病例随访时间3~36个月,未见肿瘤复发,所有患者术后肾功能均稳定。结论对于肾错构瘤破裂出血急症,经腹入路与经腹膜后入路均能有效治疗肾错构瘤破裂出血,经腹膜后入路适合直径<10 cm的肿瘤,经腹腔入路更适合直径≥10 cm的肿瘤。Objective To study different operative approach in the surgical treatment of renal angiomyolipoma complicated with bleeding from spontaneous rupture in order to remove tumor completely,protect renal function,and reduce the complications.Methods Retrospectively analyzed the clinical data of 31 patients those underwent surgical intervention due to RAML complicated bleeding from spontaneous rupture in our hospital during May 2010 and June 2018.The data including maximum tumor size,operative approach,intraoperative blood loss,operation time were reviewed and analyzed.Results All the patients were successfully rescued.Significant difference was found in tumor size between the two different operative approach(P<0.05),as well as the intraoperative blood loss and operation time(P<0.05).There was no significant difference in tumor location,warm ischemia time,change of creatinine(P>0.05).All the patients were followed-up for 3-36 months,no tumor recurrence occurred,renal function of all the patients maintained normal.Conclusions For patients suffered with renal angiomyolipoma complicated with bleeding from spontaneous rupture,both trans-abdominal approach and trans-peritoneum approach are effective.The two surgical methods have their own advantages,trans-peritoneum approach suitable for tumors diameter less than 10 cm,while trans-abdominal approach suitable for tumors diameter equal to or over 10 cm.

关 键 词：肾错构瘤 自发性破裂 手术入路 选择性肾动脉栓塞 

分 类 号：R737.11[医药卫生—肿瘤]