Seyam Raouf M, Bissada Nabil K, Kattan Said A, Mokhtar Alaa A, Aslam Muhammad, Fahmy Wahib E, Mourad Walid A, Binmahfouz Ali A, Alzahrani Hassan M, Hanash Kamal A
Department of Urology, Suez Canal University Faculty of Medicine, Ismailia, Egypt.
Urology. 2008 Nov;72(5):1077-82. doi: 10.1016/j.urology.2008.07.049. Epub 2008 Sep 21.
To evaluate the changing management of sporadic renal angiomyolipoma and renal angiomyolipoma associated with the tuberous sclerosis complex (TSC) during the past 16 years.
We retrospectively reviewed the charts of 60 patients with angiomyolipoma seen at our institutions.
The median age at presentation was 45 years (range 7-78). The presentation was pain in 30 patients and hematuria in 13; it was incidentally discovered in 17 patients. Of the 60 patients, 43 were females. TSC was present in 14 patients. The median tumor size was 4 cm (range 0.3-40, mean 6.5 +/- 1.1). Of the 60 patients, 31 were followed up expectantly. Surgery or intervention was needed for 29 patients to control hemorrhage or relieve pain or because of the suspicion of malignancy. Of these 29 patients, 12 underwent nephrectomy, 11 partial nephrectomy, and 6 embolization. The patients treated for hemorrhage had a median tumor diameter of 11 cm (range 2-21). Patients were followed up for a mean of 39.3 +/- 5.4 months. The lesions grew an average of 4.7 +/- 3.4 cm for TSC tumors and 0.6 +/- 0.2 cm for sporadic angiomyolipoma tumors. None of the patients developed renal impairment. Patients with TSC presented at a younger age, had larger and bilateral lesions, and were more symptomatic during follow-up. In the past 6 years, a significant trend was seen toward finding tumors in asymptomatic patients and toward the use of conservative or interventional (embolization) treatment.
Renal angiomyolipoma has a slow growth rate. The preservation of renal function was noted in all our patients. A recent shift was noted toward finding smaller tumors in asymptomatic patients and the use of conservative and interventional treatment.
评估过去16年中散发性肾血管平滑肌脂肪瘤及与结节性硬化症（TSC）相关的肾血管平滑肌脂肪瘤的治疗变化情况。
我们回顾性分析了在我们机构就诊的60例血管平滑肌脂肪瘤患者的病历。
就诊时的中位年龄为45岁（范围7 - 78岁）。30例患者表现为疼痛，13例为血尿；17例为偶然发现。60例患者中，43例为女性。14例患者患有TSC。肿瘤中位大小为4 cm（范围0.3 - 40 cm，平均6.5±1.1 cm）。60例患者中，31例接受了观察随访。29例患者因控制出血、缓解疼痛或怀疑恶变而需要手术或干预。在这29例患者中，12例行肾切除术，11例行部分肾切除术，6例行栓塞术。因出血接受治疗的患者肿瘤中位直径为11 cm（范围2 - 21 cm）。患者平均随访39.3±5.4个月。TSC肿瘤平均生长4.7±3.4 cm，散发性血管平滑肌脂肪瘤肿瘤平均生长0.6±0.2 cm。所有患者均未出现肾功能损害。患有TSC的患者就诊年龄较轻，病变更大且为双侧性，随访期间症状更明显。在过去6年中，出现了一个显著趋势，即更多地在无症状患者中发现肿瘤，并倾向于采用保守或介入（栓塞）治疗。
肾血管平滑肌脂肪瘤生长缓慢。我们所有患者的肾功能均得以保留。最近出现了一种趋势，即在无症状患者中发现更小的肿瘤，并采用保守和介入治疗。
