术前应用mTOR抑制剂对TSC-RAML肾部分切除术的影响  

Effects of preoperative mTOR inhibitors on partial nephrectomy for renal angiomyolipoma associated with tuberous sclerosis complex

作　　者：廖章诚 邱东旭 赵扬 王站 王旭[1] 周家权 张玉石[1] Liao Zhangcheng;Qiu Dongxu;Zhao Yang;Wang Zhan;Wang Xu;Zhou Jiaquan;Zhang Yushi(Department of Urology,Peking Union Medical College Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100730,China;Hainan General Hospital,Hainan 570311,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院泌尿外科,北京100730 [2]海南省人民医院泌尿外科,海南570311

出　　处：《中华泌尿外科杂志》2023年第9期670-674,共5页Chinese Journal of Urology

基　　金：中央高水平医院临床科研专项基金(2022-PUMCH-B-010)。

摘　　要：目的探讨术前应用哺乳动物雷帕霉素靶蛋白(mTOR)抑制剂对结节性硬化症相关肾血管平滑肌脂肪瘤(TSC-RAML)肾部分切除术的影响。方法回顾性分析2019年8月至2022年7月北京协和医院诊治的13例TSC-RAML患者的临床资料。男4例,女9例;年龄22~66岁;11例接受单侧肾部分切除术,2例接受双侧分期肾部分切除术,共计15例次手术。其中7例次手术患者术前口服mTOR抑制剂依维莫司(10 mg/d)或西罗莫司(2 mg/d)治疗至少3个月,为mTOR抑制剂组;8例次手术患者术前未服用mTOR抑制剂,为对照组。比较分析肿瘤大小、CT值以及CT强化程度(肾脏皮髓质期CT值与平扫期CT值之差)在mTOR抑制剂治疗前、后的变化,以评估mTOR抑制剂对肿瘤的影响。进一步比较mTOR抑制剂组与对照组患者手术相关临床指标,分析mTOR抑制剂对肾部分切除术的影响。结果mTOR抑制剂治疗后患者的最大肿瘤直径较治疗前明显减少[(6.4±3.1)cm与(8.7±3.9)cm],肿瘤平扫期CT值[(-18.63±48.73)HU与(-2.13±51.58)HU]和肾脏皮髓质期CT值[(13.25±64.01)HU与(47.25±66.99)HU]较治疗前均明显降低,肿瘤的CT强化程度较治疗前亦明显降低[(31.88±18.20)HU与(49.38±20.63)HU]。mTOR抑制剂组较对照组切除单位体积肿瘤所需手术时间[1.06(0.18,2.40)min/ml与1.98(0.39,5.03)min/ml]和肾脏热缺血时间[0.17(0.03,0.79)min/ml与0.34(0.10,1.71)min/ml]均有缩短趋势,且单位体积肿瘤.术中出血量[0.72(0.19,0.88)ml/ml与1.69(0.59,4.54)m/ml]亦有减少趋势。结论TSC-RAML患者术前服用mTOR抑制剂具有缩小TSC-RAML直径、减少肿瘤血运、缩短肾部分切除术手术时间.和肾脏热缺血时间,以及减少术中出血量的潜能,有助于提高手术的安全性和保护肾功能。Objective To investigate the effects of preoperative mammalian target of rapamycin(mTOR)inhibitor on partial nephrectomy for renal angiomyolipoma associated with tuberous sclerosis complex(TSC-RAML).Methods A retrospective analysis was conducted on clinical data from 13 patients who were diagnosed with TSC-RAML and treated at Peking Union Medical College Hospital between August 2019 and July 2022.This cohort included 4 males and 9 females,with ages ranging from 22 to 66 years.All patients underwent partial nephrectomy,with 2 patients requiring two-stage surgeries due to bilateral RAMLs,resulting in a total of 15 surgeries being performed.Preoperative mTOR inhibitors,specifically everolimus(10 mg/d)or sirolimus(2 mg/d),were administered orally for at least 3 months prior to 7 of the surgeries.The effects of mTOR inhibitors on tumor size,tumor computed tomography attenuation value(CT value),and tumor CT enhancement were evaluated.The comparison of surgery-related clinical parameters was conducted between patients who received preoperative mTOR inhibitors and those who did not to assess the influences of mTOR inhibitors on surgery.Results Compared to the baseline tumor,there was a significant reduction in tumor diameter after mTOR treatment[(6.4±3.1)cm vs.(8.7±3.9)cm],as well as in the CT value in both the unenhanced phase[(-18.63±48.73)HU vs.(-2.13±51.58)HU]and corticomedullary phase[(13.25±64.01)HU vs.(47.25±66.99)HU].Additionally,tumor CT enhancement also decreased as compared with that before treatment[(31.88±18.20)HU vs.(49.38±20.63)HU].Patients who received preoperative mTOR inhibitor showed a trend towards shorter operative time for removing per milliliter of tumor compared to those without preoperative mTOR inhibitor[1.06(0.18,2.40)min/ml vs.1.98(0.39,5.03)min/ml]and so was the renal artery clamping time[0.17(0.03,0.79)min/ml vs.0.34(0.10,1.71)min/ml].Additionally,the amount of intraoperative bleeding for removing per milliliter of tumor was lower in patients with preoperative mTOR inhibitors compare

关 键 词：结节性硬化症 肾血管平滑肌脂肪瘤 哺乳动物雷帕霉素靶蛋白抑制剂 肾部分切除术 

分 类 号：R737.11[医药卫生—肿瘤]