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目的探讨肾错构瘤的临床特征、诊断及治疗。方法肾错构瘤患者28例,按直径对其分组,I组(d<4cm)7例,II组(48cm)5例。I组患者6例无明显临床症状,治疗以定期复查、随诊为主;II组患者15例有不同程度的临床症状,行保留肾单位手术(Nephron-sparing surgery,NSS)12例,行肾切除术3例,行患肾根治性切除术1例;III组患者中5例有临床症状,所有患者均接受手术治疗,其中行NSS手术3例,行肾切除术2例。结果所有手术患者经病理确诊为肾错构瘤(renal angiomyolipoma,RAML),Ⅰ组7例中6例肿瘤大小无明显变化,1例肿瘤增大。Ⅱ组所有患者恢复良好。Ⅲ组3例行肾部分切除,其中1例术后复发。再次行肿瘤剜除术,术后康复出院,随访恢复良好。结论对于肾错构瘤,肿瘤直径<4cm者,治疗可以定期复查、随诊为主;而对于肿瘤直径≥4cm的患者,考虑肿瘤破裂出血可能性大,应积极进行外科治疗,首选保留肾单位手术,以免造成严重后果。
Objective To investigate the clinical features, diagnosis and treatment of renal hamartoma. Methods 28 patients with renal hamartoma were divided into groups according to their diameters. There were 7 cases in group I (d <4cm), 16 cases in group II (4 8cm). Six patients in group I had no obvious clinical symptoms. The patients were followed up regularly. Fifteen patients in group II had some degree of clinical symptoms. Nephron-sparing surgery (NSS) was performed in 12 patients, Three cases underwent resection and one case underwent radical nephrectomy. Five cases in group III had clinical symptoms. All patients underwent surgical treatment. Three cases underwent NSS and two cases underwent nephrectomy. Results All patients were pathologically diagnosed as renal angiomyolipoma (RAML). There was no significant change in the size of the tumors in 6 of 7 patients in group Ⅰ, and one of the tumors in 1 patient. All patients in group Ⅱ recovered well. Three cases of group Ⅲ partial resection of the kidney, including 1 case of recurrence. Tumor resection again surgery, postoperative recovery discharged, follow-up recovered well. Conclusion For renal hamartoma, the diameter of tumor <4cm, the treatment can be reviewed regularly, followed up mainly; and for patients with tumor diameter ≥ 4cm, consider the possibility of tumor rupture bleeding should be actively surgical treatment, the preferred retention of nephron Surgery, so as to avoid serious consequences.