CLINICAL STUDY OF RENAL ANGIOMYOLIPOMA IN KYUSHU DISTRICT

点击翻译按钮获取中文摘要

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