不同治疗方式处理肾错构瘤破裂出血的多中心回顾
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汕头市中心医院（中山大学附属汕头医院）1 泌尿外科，4 介入科（广东汕头 515031）；2 汕头大学医学院第一 附属医院泌尿外科（广东汕头 515041）；3 汕头大学医学院第二附属医院泌尿外科（广东汕头 515021）
【摘要】 目的 探讨不同的治疗手段处理肾错构瘤（renal angiomyolipoma ，RAML）破裂出血的治疗 效果。方法 回顾性总结 2010-2018 年广东省汕头市三家“三级甲等”医院的收治的肾错构瘤破裂出血病 例 106 例，通过手术、介入及保守三种方式进行积极抢救治疗。统计并分析肿瘤最大直径、肿瘤的位置、平 均出血量、治疗时间、住院时间、住院费用、肿瘤缩小率、并发症、血肌酐变化值之间的关系。结果 所有 病例均得以成功救治。在肿瘤的直径大小和肿瘤的位置方面，三组之间差异无统计学意义（P > 0.05）。 介入组在治疗时间、平均出血量上明显低于手术组（P < 0.05）。在住院时间、并发症发生率、肿瘤缩小率 等方面，手术组住院时间明显长于另外两组，并发症发生率、肿瘤缩小率明显高于另外两组（P < 0.05）；在 血肌酐变化和治疗费用方面，保守组的血肌酐变化最小、治疗费用最低（P < 0.05）。结论 对于肾错构瘤 破裂出血急症，介入治疗在治疗时间、住院时间、出血量、并发症发生率均明显低于手术治疗，已得到广泛 认可。手术治疗能显著缩小肿瘤，效果确切，但对当地医疗水平、血源准备等条件要求较高。保守治疗适 用于病情较轻的情况，但仍有后续再出血可能。
【关键词】 肾错构瘤； 自发性破裂； 选择性肾动脉栓塞
Different treatments for renal angiomyolipoma with spontaneous rupture in multicenter ZHANG Yuan⁃ feng*，CHEN Si，CHEN Jie，LIN Gangyi，LIN Weiqiang，XU Qingchun，ZHANG Yonghai. *Department of Urolo⁃ gy，the Shantou Central Hospital（The Affiliated Hospital of Sun Yatsen university），Shantou 515031，China Corresponding author：ZHANG Yonghai E⁃mail：stone_405@163.com
【Abstract】 Objective To study different treatments of renal angiomyolipoma with spontaneous rupture in order to improve the success rate of rescue，protect renal function. Methods Between 2010 and 2018，106 patients of RAML with spontaneous rupture from three“ Grade 3A ”hospitals who underwent surgical intervention or angioembolization or conservative treatment were enrolled and retrospectively analyzed. The maximum diameter of the tumor，the location of the tumor，the average volume of blood loss，the duration of treatment，the cost of hospi⁃ talization，the reduction rate of the tumor，the complications，and the changes in serum creatinine were calculated and analyzed. Result All the patients were successful rescued. Significant difference was found. There was no significant difference in the diameter and location of the tumors among the three groups（P > 0.05）. In the interven⁃ tional group，the time of treatment and the average amount of bleeding were significantly lower than those in the operation group（P < 0.05）. The length of hospital stay in the operation group was significantly longer than that in the other two groups，the incidence of complications and the tumor reduction rate were significantly higher than those in the other two groups（P < 0.05）. The conservative group had the smallest change in serum creatinine and the lowest hospitalization cost（P < 0.05）. Conclusions The duration of treatment，the cost of hospitalization， the amount of bleeding and the incidence of complications of the interventional therapy are obviously lower than those of surgical treatment ，which has been widely recognized. Surgical treatment can significantly reduce the tumor，the effect is accurate，but the local medical level，blood insufficient are major issues that we have to face with. Conservative treatment is suitable for mild cases，but there is a possibility of subsequent rebleeding.
2746
实用医学杂志 2019 年第 35 卷第 17 期 The Journal of Practical Medicine 2019 Vol.35 No.17
·临 床 研 究·
不同治疗方wenku.baidu.com处理肾错构瘤破裂出血的多中心回顾
张源锋 1 陈思 2 陈捷 3 林纲毅 4 林伟强 1 徐庆春 1 张永海 1
【摘要】 目的 探讨不同的治疗手段处理肾错构瘤（renal angiomyolipoma ，RAML）破裂出血的治疗 效果。方法 回顾性总结 2010-2018 年广东省汕头市三家“三级甲等”医院的收治的肾错构瘤破裂出血病 例 106 例，通过手术、介入及保守三种方式进行积极抢救治疗。统计并分析肿瘤最大直径、肿瘤的位置、平 均出血量、治疗时间、住院时间、住院费用、肿瘤缩小率、并发症、血肌酐变化值之间的关系。结果 所有 病例均得以成功救治。在肿瘤的直径大小和肿瘤的位置方面，三组之间差异无统计学意义（P > 0.05）。 介入组在治疗时间、平均出血量上明显低于手术组（P < 0.05）。在住院时间、并发症发生率、肿瘤缩小率 等方面，手术组住院时间明显长于另外两组，并发症发生率、肿瘤缩小率明显高于另外两组（P < 0.05）；在 血肌酐变化和治疗费用方面，保守组的血肌酐变化最小、治疗费用最低（P < 0.05）。结论 对于肾错构瘤 破裂出血急症，介入治疗在治疗时间、住院时间、出血量、并发症发生率均明显低于手术治疗，已得到广泛 认可。手术治疗能显著缩小肿瘤，效果确切，但对当地医疗水平、血源准备等条件要求较高。保守治疗适 用于病情较轻的情况，但仍有后续再出血可能。
【关键词】 肾错构瘤； 自发性破裂； 选择性肾动脉栓塞
Different treatments for renal angiomyolipoma with spontaneous rupture in multicenter ZHANG Yuan⁃ feng*，CHEN Si，CHEN Jie，LIN Gangyi，LIN Weiqiang，XU Qingchun，ZHANG Yonghai. *Department of Urolo⁃ gy，the Shantou Central Hospital（The Affiliated Hospital of Sun Yatsen university），Shantou 515031，China Corresponding author：ZHANG Yonghai E⁃mail：stone_405@163.com
【Abstract】 Objective To study different treatments of renal angiomyolipoma with spontaneous rupture in order to improve the success rate of rescue，protect renal function. Methods Between 2010 and 2018，106 patients of RAML with spontaneous rupture from three“ Grade 3A ”hospitals who underwent surgical intervention or angioembolization or conservative treatment were enrolled and retrospectively analyzed. The maximum diameter of the tumor，the location of the tumor，the average volume of blood loss，the duration of treatment，the cost of hospi⁃ talization，the reduction rate of the tumor，the complications，and the changes in serum creatinine were calculated and analyzed. Result All the patients were successful rescued. Significant difference was found. There was no significant difference in the diameter and location of the tumors among the three groups（P > 0.05）. In the interven⁃ tional group，the time of treatment and the average amount of bleeding were significantly lower than those in the operation group（P < 0.05）. The length of hospital stay in the operation group was significantly longer than that in the other two groups，the incidence of complications and the tumor reduction rate were significantly higher than those in the other two groups（P < 0.05）. The conservative group had the smallest change in serum creatinine and the lowest hospitalization cost（P < 0.05）. Conclusions The duration of treatment，the cost of hospitalization， the amount of bleeding and the incidence of complications of the interventional therapy are obviously lower than those of surgical treatment ，which has been widely recognized. Surgical treatment can significantly reduce the tumor，the effect is accurate，but the local medical level，blood insufficient are major issues that we have to face with. Conservative treatment is suitable for mild cases，but there is a possibility of subsequent rebleeding.
2746
实用医学杂志 2019 年第 35 卷第 17 期 The Journal of Practical Medicine 2019 Vol.35 No.17
·临 床 研 究·
不同治疗方wenku.baidu.com处理肾错构瘤破裂出血的多中心回顾
张源锋 1 陈思 2 陈捷 3 林纲毅 4 林伟强 1 徐庆春 1 张永海 1