Byrd Gregory F, Lawatsch Eric J, Mesrobian Hrair-George, Begun Frank, Langenstroer Peter
Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226-3596, USA.
J Urol. 2006 Oct;176(4 Pt 1):1512-6; discussion 1516. doi: 10.1016/j.juro.2006.06.013.
Angiomyolipomas are rare benign renal tumors which occasionally require intervention. Preservation of renal function is essential when treating renal angiomyolipoma in patients with multiple or bilateral lesions. We report on the first series of patients with renal angiomyolipoma treated with laparoscopic cryoablation.
Seven patients with pathologically confirmed renal angiomyolipoma underwent laparoscopic cryoablation. Transperitoneal surgery with intraoperative ultrasound was performed, followed by clinical monitoring with creatinine and axial imaging.
Mean patient age was 44.9 years. Six patients were female, and 2 patients had associated tuberous sclerosis and multiple bilateral angiomyolipoma. In 1 patient 5 lesions were treated, in another 3 lesions were treated and in the remaining patients solitary lesions were treated. The average size of the largest lesion in each patient was 4.2 cm (range 2.5 to 7.0). The procedures were tolerated well with 3 minor complications in 2 patients. Average operative time was 170 minutes (range 137 to 232) and decreased as expertise was gained. Average estimated blood loss was 116 cc (range 15 to 250). Renal function was preserved, with mean preoperative and postoperative creatinine 0.83 (range 0.6 to 1.6) and 0.91 (range 0.7 to 1.8), respectively. Average decrease in estimated creatinine clearance was 8.6 ml per minute. Followup imaging using computerized tomography or magnetic resonance imaging showed reduction in lesion size, lack of blood flow and no subsequent regrowth in all patients.
Laparoscopic cryoablation is a safe and feasible minimally invasive, nephron sparing alternative for the treatment of angiomyolipoma.
血管平滑肌脂肪瘤是一种罕见的肾脏良性肿瘤，偶尔需要进行干预。对于患有多发或双侧病变的肾血管平滑肌脂肪瘤患者，保留肾功能至关重要。我们报告了首例接受腹腔镜冷冻消融治疗的肾血管平滑肌脂肪瘤患者系列。
7例经病理证实的肾血管平滑肌脂肪瘤患者接受了腹腔镜冷冻消融治疗。采用经腹手术并术中使用超声，随后进行肌酐临床监测和轴向成像。
患者平均年龄为44.9岁。6例为女性，2例患有结节性硬化症及多发双侧血管平滑肌脂肪瘤。1例患者治疗了5个病灶，另1例治疗了3个病灶，其余患者治疗的是孤立病灶。每位患者最大病灶的平均大小为4.2厘米（范围为2.5至7.0厘米）。手术耐受性良好，2例患者出现3例轻微并发症。平均手术时间为170分钟（范围为137至232分钟），随着经验的积累而缩短。平均估计失血量为116毫升（范围为15至250毫升）。肾功能得以保留，术前和术后肌酐平均值分别为0.83（范围为0.6至1.6）和0.91（范围为0.7至1.8）。估计肌酐清除率平均下降8.6毫升/分钟。使用计算机断层扫描或磁共振成像进行的随访成像显示，所有患者的病灶大小均减小，无血流信号且无后续复发。
腹腔镜冷冻消融是一种安全可行的微创、保留肾单位的治疗血管平滑肌脂肪瘤的替代方法。
