Kara Onder, Akca Oktay, Zargar Homayoun, Andrade Hiury Silva, Maurice Matthew Joseph, Ramirez Daniel, Caputo Peter, Haber George-Pascal, Kaouk Jihad H, Stein Robert J
Glickman Urological and Kidney Institute, Cleveland Clinic , Cleveland, Ohio.
J Endourol. 2016 Mar;30(3):275-9. doi: 10.1089/end.2015.0624. Epub 2015 Dec 11.
To present the experience and efficacy of Robotic Partial Nephrectomy (RPN) for the management of renal angiomyolipomas (AMLs) with regard to renal function preservation and perioperative outcomes.
We retrospectively searched our RPN database for pathologically confirmed renal AML patients between 2006 and 2014. Clinical presentation, perioperative complications, and postoperative outcomes of the patients were analyzed. Preoperative imaging findings were reviewed to examine their ability to predict pathology of AML.
From 1005 RPN performed in our center during the study period, 53 patients met our inclusion criteria. The mean age at presentation was 54.1 (± 13) years, and 42 (79.2%) patients were female. Median tumor size was 2.8 (interquartile range [IQR], 1.8-4.6) cm. The indication for RPN was suspicious radiologic features for malignancy in 42 (79.2%) patients and acute retroperitoneal hemorrhage risk and pain in 11 (20.8%) patients who were found to have AML according to preoperative imaging. Mean estimated blood loss was 198 (± 194) mL, and 5 (9.4%) patients required blood transfusion. Postoperative complications occurred in 8 (15%) patients. Median estimated glomerular filtration rate within the latest follow-up was 86.9 (IQR, 69.7-100.1) mL/minute/1.73 m(2) with a median of 91% (IQR, 80.4-103) preservation. None of patients developed urinary fistula or pseudoaneurysm requiring second intervention. No local recurrences occurred with a median follow-up of 7 (IQR, 1-17) months.
Given the low complication rate and preservation of renal function after RPN for AML, it can be considered a reliable method for AML treatment. The majority of AMLs were not suspected based on preoperative imaging. Further diagnostic methods are needed to differentiate benign from malignant lesions.
介绍机器人辅助部分肾切除术（RPN）治疗肾血管平滑肌脂肪瘤（AML）在肾功能保留和围手术期结果方面的经验及疗效。
我们回顾性检索了2006年至2014年间经病理证实的肾AML患者的RPN数据库。分析患者的临床表现、围手术期并发症及术后结果。回顾术前影像学检查结果以评估其预测AML病理的能力。
在研究期间我们中心进行的1005例RPN中，53例患者符合纳入标准。就诊时的平均年龄为54.1（±13）岁，42例（79.2%）为女性。肿瘤中位数大小为2.8（四分位间距[IQR]，1.8 - 4.6）cm。RPN的指征为42例（79.2%）患者存在可疑的恶性放射学特征，11例（20.8%）患者根据术前影像学检查发现AML且有急性腹膜后出血风险和疼痛。平均估计失血量为198（±194）mL，5例（9.4%）患者需要输血。8例（15%）患者发生术后并发症。最近一次随访时估计肾小球滤过率中位数为86.9（IQR，69.7 - 100.1）mL/分钟/1.73 m²，保留率中位数为91%（IQR，80.4 - 103）。无一例患者发生需要二次干预的尿瘘或假性动脉瘤。中位随访7（IQR，1 - 17）个月无局部复发。
鉴于RPN治疗AML后的低并发症率及肾功能保留情况，可将其视为治疗AML的可靠方法。大多数AML术前影像学检查未怀疑。需要进一步的诊断方法来区分良性与恶性病变。
