保留肾单位手术治疗肾窦血管平滑肌脂肪瘤的经验总结  

Surgical experience of nephron-sparing surgery for the treatment of renal sinus angiomyolipoma

作　　者：徐楚潇 潘大猛 刘磊[1] 王国良[1] 马潞林[1] 张树栋[1] XU Chuxiao;PAN Dameng;LIU Lei;WANG Guoliang;MA Lulin;ZHANG Shudong(Department of Urology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院泌尿外科,北京100191

出　　处：《现代泌尿外科杂志》2024年第12期1064-1068,共5页Journal of Modern Urology

摘　　要：目的分析保留肾单位手术(NSS)治疗肾窦血管平滑肌脂肪瘤(AML)的疗效,并总结手术经验。方法回顾性分析2014年9月—2022年2月北京大学第三医院泌尿外科收治的10例成功行NSS治疗的肾窦AML患者的临床和随访资料。结果10例患者中男性1例、女性9例,平均肿瘤直径(5.7±2.8)cm。RENAL评分8分1例、9分3例、10分4例、11分2例。3例行后腹腔镜肾部分切除术、3例行机器人辅助腹腔镜肾部分切除术、4例行经腹入路开放肾部分切除术,手术均获成功,中位手术时间225(97~340)min、中位热缺血时间30.5(5~43)min,患者4和7同时阻断肾静脉,静脉阻断时间分别为18 min和29 min。中位术中出血量200(10~600)mL,所有患者均未输血。术后血红蛋白水平和术前相比差异有统计学意义[113(94~130)g/L vs.136(95~150)g/L,P=0.041];术后血肌酐水平与术前相比差异无统计学意义[58(35~89)μmol/L vs.62(39~77)μmol/L,P=0.722]。1例(患者2)患者术后发生淋巴漏(Clavien-DindoⅠ级),经保守治疗后自愈。1例(患者1)患者随访99个月发现肿瘤复发,其余9例无瘤生存,肾功能良好。结论NSS是肾窦AML的有效治疗方式,完整切除是其中关键,但仍可能复发,因此建议长期严密随访。Objective To investigate the efficacy of nephron-sparing surgery(NSS)for the treatment of renal sinus angiomyolipoma and summarize the surgical experience.Methods The clinical data and follow-up results of 10 cases of renal sinus angiomyolipoma treated during Sep.2014 and Feb.2022 in our hospital were retrospectively analyzed.Results The patients included 1 male and 9 female.The mean tumor diameter was(5.7±2.8)cm.The RENAL score was 8 in 1 case,9 in 3 cases,10 in 4 cases,and 11 in 2 cases.Retroperitoneal laparoscopic partial nephrectomy was conducted in 3 cases,robot-assisted laparoscopic partial nephrectomy in 3 cases,and open partial nephrectomy by transabdominal approach in 4 cases.All operations were successful.The median operation time was 225(97-340)minutes and the median warm ischemic time was 30.5(5-43)minutes.Two patients underwent renal vein clamping simultaneously,with clamping time of 18 and 29 minutes,respectively.The median estimated blood loss was 200(10-600)mL,and no patients received blood transfusion.The difference between postoperative and preoperative hemoglobin concentration was statistically significant[113(94-130)g/L vs.136(95-150)g/L,P=0.041].The difference between the postoperative and preoperative serum creatinine level was not statistically significant[58(35-89)μmol/L vs.62(39-77)μmol/L,P=0.722].One case suffered lymphorrhagia(Clavien-Dindo gradeⅠ)and recovered with conservative treatment;1 case experienced local recurrence after a follow-up of 99 months;9 patients recovered uneventfully without any postoperative complications.Conclusion NSS is an effective treatment strategy for renal sinus angiomyolipoma.Complete resection plays a key role.Due to possible recurrence,long-term follow-up is recommended.

关 键 词：肾肿瘤 血管平滑肌脂肪瘤 肾窦 保留肾单位手术 

分 类 号：R737.11[医药卫生—肿瘤]