选择性肾动脉栓塞联合腹腔镜肾部分切除术治疗肾错构瘤自发性破裂（附23例报告）

摘要

Objective To investigate the safety and feasibility of selective renal arterial embolization combined with laparoscopic partial nephrectomy in treatment of renal angiomyolipoma with spontaneous rupture.Method Retrospective analysis was conducted based on the clinical data of 23 cases of renal angiomyolipoma with spontaneous rupture from January 2009 to August 2014, and the mean tumor size of the patients was 5.5 cm. Retroperitoneal laparoscopic nephron-sparing surgery was performed 24~72h after selective renal artery embolization. The operative time, intraoperative blood loss, complications and hospital stay were analyzed.Result All the operations were performed successfully. No one required additional open surgery. The mean operating time and blood loss was 123min and 90 ml, respectively. The mean hospital stay was 9.2d. 2 cases suffered urinary fistula posteroperatively but recovered after conservative treatment. After the procedure, total renal function was normal and no other serious complications occurred. During the follow-up lasting for 6 months to 4 years, no tumor recurrence was found.Conclusion Selective renal arterial embolization combined with laparoscopic partial nephrectomy is feasible and safe for renal angiomyolipoma with spontaneous rupture in well selected and prepared patients by experienced operators.%目的：探讨选择性肾动脉栓塞联合腹腔镜肾部分切除术治疗肾错构瘤自发性破裂的安全性和有效性。方法回顾性总结分析本院2009年1月至2014年8月收治的23例肾错构瘤自发性破裂的临床诊治资料，肿瘤直径平均5.5cm。腹腔镜肾部分切除术于肿瘤靶标血管栓塞后24～72小时实施，观察手术时间、术中出血量、术中术后并发症及术后住院时间等。结果腹腔镜手术均获成功，手术时间平均123分钟，术中出血量平均90ml，术后住院时间平均9.2天。2例术后出现尿瘘，保守治愈后出院。术后肾功能无明显受损，无其他严重并发症出现。随访6个月至4年，未见肿瘤复发。结论选择性肾动脉栓塞联合腹腔镜肾部分切除术治疗临近肾错构瘤自发性破裂安全可行、创伤小，术者需具有熟练的腹腔镜技术，术前需充分准备。