CLINICAL STUDY OF RENAL ANGIOMYOLIPOMA IN KYUSHU DISTRICT

从1998年1月至2002年12月，267例（290个肾脏）AML患者在61个研究所在日本九州，并进行了回顾性分析。AML通过组织学或计算机断层扫描结合磁共振成像或超声诊断。67名男性的年龄范围为20 - 86岁（平均53.2岁），而200名女性的年龄范围为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无TS患者。在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。临床表现为意外发现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%）。未破裂的肿瘤大小为0.5 ~ 25 cm（平均2.9 cm），破裂的肿瘤大小为3 ~ 24 cm（9.1 cm）。破裂的肿瘤大小为s ...更多信息 瘤体直径明显大于未破裂者（P<0.01）。267例患者中16例发生AML破裂（6%），5例发生TS（31.3%）。非破裂肾的治疗包括观察202/268（75.4%），肾切除28/268（10.5%），动脉栓塞21/268（7.8%），肾部分切除或剜出17/268（6.3%）。肾动脉栓塞7例（43.8%），肾切除6例（37.5%），观察3例（18.8%）。对于logistic回归分析，肿瘤直径（≥ 4 cm）（比值比3.65 ; 95% CI：1.25 - 10.54）是高生长率的唯一显著预测因素。肿瘤直径（4cm）是高生长率的临界点。25例栓塞后肿瘤行CT随访。25个栓塞肿瘤中有22个（88%）肿瘤最大直径减小。栓塞前平均最大肿瘤直径为4.9±2.9 cm，栓塞后为2.9±2.7 cm（平均随访时间为27.6个月，栓塞后平均减少45.2±30.5%）。栓塞对大多数症状性AML有效。此外，预防性选择性栓塞可能是可行的无症状肿瘤。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