CLINICAL STUDY OF RENAL ANGIOMYOLIPOMA IN KYUSHU DISTRICT

1998年1月至2002年12月，对日本九州61所医院的267例AML患者（290个肾脏）进行回顾性分析。急性髓性白血病的诊断采用组织学或计算机断层扫描结合磁共振成像或超声检查。男性67例，年龄20 ~ 86岁，平均53.2岁；女性200例，年龄24 ~ 78岁，平均52.1岁。22例（8.2%）诊断为结节性硬化症（TS）。TS患者的年龄明显小于非TS患者，267例患者中，123例（46.1%）为左侧肿瘤，121例（45.3%）为右侧肿瘤，23例（8.6%）为双侧肿瘤。症状和体征包括意外发现197例（73.8%），疼痛34例（12.7%），肉眼血尿25例（9.4%），急性出血2例（0.7%）。未破裂肿瘤大小为0.5 ~ 25cm（平均2.9cm），破裂肿瘤大小为3 ~ 24cm（平均9.1cm）。破裂肿瘤的大小大于未破裂肿瘤的大小（P<0.01）。267例患者中有16例（6%）发生急性髓性白血病破裂，16例患者中有5例（31.3%）发生TS。未破裂肾的治疗包括268例肾脏中观察202例（75.4%），肾切除术28例（10.5%），动脉栓塞21例（7.8%），部分肾切除术或去核17例（6.3%）。肾破裂16例中动脉栓塞7例（43.8%），肾切除术6例（37.5%），观察3例（18.8%）。在logistic回归分析中，肿瘤直径（=4 cm）（优势比3.65;95% CI: 1.25 ~ 10.54）是高生长率的唯一显著预测因子。肿瘤直径（4cm）是高生长速度的临界点。对25例栓塞瘤行CT随访。25例栓塞肿瘤中22例（88%）最大肿瘤直径减小。栓塞前平均最大肿瘤直径为4.9±2.9 cm，栓塞后平均最大肿瘤直径为2.9±2.7 cm（平均随访时间27.6个月，栓塞后平均缩小比例为45.2±30.5%）。栓塞对大多数有症状的aml是有效的。此外，预防性选择性栓塞对于无症状的肿瘤也是可行的。少

From January 1998 to December 2002, 267 patients (290 kidneys) with AML were seen at 61 institutes throughout Kyushu, Japan, and were retrospectively analyzed. AML was diagnosed by histology or computed tomography combined with magnetic resonance imaging or ultrasonography. The age of 67 males ranged from 20 to 86 years (mean 53.2 years) while that of 200 females ranged from 24 to 78 years (mean 52.1 years). Twenty-two patients (8.2%) had the diagnosis of tuberous sclerosis (TS). The age of patients with TS was significantly younger than that of patients without TS. Of the 267 patients, 123 (46.1%) had a left-side tumor, 121(45.3%) had a right-side tumor and 23 (8.6%) had bilateral tumors. Presenting symptoms and signs included incidental discovery 197(73.8%), pain 34 (12.7%), gross hematuria 25 (9.4%) and acute hemorrhage 2 (0.7%). The non-ruptured tumor size ranged from 0.5 to 25 cm (mean 2.9cm) and the ruptured tumor size ranged from 3 to 24 cm (9.1cm). The ruptured tumor size was s … More ignificantly larger than the non-ruptured tumor size (P<0.01). The rupture of AML occurred in 16 of 267 patients (6 %) and 5 of 16 (31.3%) had TS. Treatment of non-ruptured kidney consisted of observation in 202 (75.4%) of 268 kidneys, nephrectomy in 28 (10.5%), arterial embolization in 21 (7.8%) and partial nephrectomy or enucleation in 17(6.3%). Treatment of ruptured kidney consisted of arterial embolization in 7 (43.8%) of 16 kidneys, nephrectomy in 6 (37.5%) and observation in 3 (18.8%). For logistic regression analysis, tumor diameter (=4 cm) (odds ratio 3.65 ; 95% CI : 1.25 to 10.54) was the only significant predictor of high growth rate. Tumor diameter (4 cm) was a critical point for high growth rate. Follow-up CT was performed in 25 embolization tumors. The maximal tumor diameter was reduced in 22 (88%) of the 25 embolization tumors. The average maximal tumor diameter just before embolization was 4.9±2.9 cm and was 2.9±2.7 cm after embolization (the mean follow-up duration 27.6 months, an average reduced percentage of postembolization 45.2±30.5%). Embolization is effective in most symptomatic AMLs. In addition prophylactic selective embolization may be feasible for asymptomatic tumors. Less