肾错构瘤自发性破裂出血的诊治.DOCVIP

临床医学论文-肾错构瘤自发性破裂出血的诊治 ?????????????? 作者：黄勇, 袁亚光, 闫俊, 朱小军 【摘要】? 目的 探讨肾错构瘤破裂出血的诊断和治疗方法。方法 回顾分析1997～2006年诊治的14例肾错构瘤破裂出血患者的临床资料，14例患者均行B超及CT检查，12例行肾切除术，1例行肿瘤剜除术，1例行保守治疗。结果 13例患者术后恢复良好，1例剜除术患者经14个月随访，未见复发，1例行保守治疗者病情稳定。结论 B超和CT检查对诊断肾错构瘤破裂出血有帮助，并能提示病变的性质以及确定出血的范围，直径大于4cm的肾错构瘤应积极手术治疗，手术时应尽量保留有功能的肾组织。 【关键词】? 肾肿瘤； 错构瘤； 自发性破裂 ????? Diagnosis and treatment of renal angiomyolipoma with spontaneous rupture hemorrhage ??? HUANG Yong, YUAN Ya-guang, YAN Jun, et al.Department of Urology, The Affiliated Hospital of Inner Mongolian Medical College，Huhhot 010050,China ??? 【Abstract】? Objective? To study the methods for diagnosis and treatment of renal angiomyolipoma with spontaneous rupture.Methods?? The clinical data of 14 cases with renal angiomyolipoma rupture were reviewed. All the patients were examined by ultrasonography and CT scanning. Twelve received nephrectomy , one received partial nephrectomy , one case treated conservatively.Results?Thirteen patients underwent surgical operation restored to health smoothly, one patient received partial nephrectomy were healthy and the other patient treated conservatively had no?change with his disease. Conclusions?Ultrasound and CT scanning are helpful with the diagnosis which may confirm the character of the lesion and the range of bleeding. If the tumour exceeds 4 cm, active treatment should be considered. Any operative management should preserve the functional nephrons as much as possible. ??? 【Key words】? renal neoplasms;angiomyolipoma;spontaneous repture ??? 肾错构瘤又称肾血管平滑肌脂肪瘤，是较少见的肾良性肿瘤。由于早期无任何症状，常不能引起注意，肿瘤一旦破裂出血引起严重的临床症状，如果诊治不及时，甚至危及患者的生命。我院于1997～2006年收治肾错构瘤破裂出血患者14例，现将其诊治情况报告如下。 ??? 1? 临床资料 ??? 1.1? 一般资料? 本组14例，男5例，女9例；年龄23～60岁，平均42.5岁。肿瘤位于右侧8例，左侧6例。9例有突发性腰腹部疼痛，伴面色苍白，其中5例同时有恶心、呕吐等胃肠道症状，3例为腰腹部不适伴肉眼血尿，2例为只有腰腹部不适，无肉眼血尿。 ??? 1.2? 影像学检查? 14例均行B超和CT检查。B超显示6例呈典型表现，诊断为肾错构瘤破裂出血，7例诊断为肾肿瘤、肾周筋膜有出血影，1例诊断为肾囊实性肿块，边界不清，其内表现有强光团，周边有液性暗区。CT检查10例诊断为肾错构瘤破裂出血，4例诊断为肾脏占位性病变。所有病例瘤体直径均大于4cm，最大8cm×11cm×15cm。 ??? 2? 结果 ??? 13例患者术后恢复良好，病理检查均报告为肾错构瘤，未发现恶变。其中