肾血管平滑肌脂肪瘤的诊断和治疗(3)
(2)严重症状(出血，无法控制的疼痛)患者采用保留肾组织手术或动脉栓塞。选择性动脉栓塞还适用于手术有危险、不愿手术或用于控制由于出血所致的症状等。可采用无水酒精、聚乙烯酒精泡沫粉剂+明胶海绵以及Gianturco圈等材料。由于选择性动脉栓塞能保留正常肾组织，使血管及平滑肌成分消失，脂肪成分液化或呈囊性改变，是肾血管平滑肌脂肪瘤的有效治疗方法。Han(1997)应用于14例，13例在随期间(7~72个月，平均33个月)症状消失，1例症状消失后1个月肿瘤复发，2例因肿瘤长大而再次栓塞。肿瘤缩小26%~99%(平均70.2%)。血管及平滑肌成分几乎完全消失，而脂肪成分变化不大，仅1例因脂肪液化呈大的囊性变化而需干预，无严重并发症。7例腹膜后、肿瘤内、肾周围或包膜下血肿均被吸收，是一种有效的治疗方法。因本病有可能是双侧病变，且其生长常不同步，肾切除必须谨慎。
保留肾组织手术包括肿瘤剜除术，肾部分切除。有时肿瘤周围血管极为丰富，术中出血不易控制而被迫切除肾脏。对大的肿瘤术前可考虑作选择性肾动脉造影，了解血供及其走向，有助于保留肾手术的旅行。术中阻断肾动脉亦有利于保留肾手术的施行。
, 百拇医药
参考文献：
1.Arie Belldegrun & Jean B. Dedernion: Renal Tumors, in Campbell’s Urology vol III 7th Edition. Edited by Walsh Petrik and Stammy Vallghan, W. B. Saunders Company, 1998, P. 2883.
2.Steiner MS, Goldman SM, Fishman eK, et al. The National History of AMLs. J. Urol, 1993, 150:1782-1786.
3.Y. M. H., J. M. L., Y. H. L., et al. Renal Angiomyolipoma: Selective Arterial Embolization-Effectiveness and changes in Angiomyogenic Components in Long-term Followup. 1997, 204: 65-70.
, 百拇医药
4.M Jinzaki, A. Tanimoto, Y. Narimatsu, et al. Angiomyolipoma: Imaging Findinjgs in Lesions with Minimal Fat. Radilogy, 1997, 205: 497-502.
5.Lamaitre L, Robert Y, Dubrule F, et al. Renal Angiomyolipoma: growth followup with CT and/or US. Radiology, 1995, 197: 598-602.
6.Oesterling JE, Fishman EK, Goldman SM, et al. The managemetn of renal angiomyolipoma. J, Urol., 1986, 135:1121-1124.
7.Helenon O, Merran S, Paraf F, et al. Unusual fat-containing tumors of the kidney: diagnostic de=ilemma. Radiographics, 1997, 17:129-144.
, http://www.100md.com
8.N. Taniguchi, K. Itoh, S. Nakmura. Differentiation of renal cell Carciuowas from Angimyolipomas by Ultrasonic Frequency Dependent Attenuation. J. Urol, 1997, 157:1242-1245.
9.Kwai-Fong NG and Tse-Ching Chen. Infiltrating Renal Angiomyolipoma into Asending Colocn association with Hepatic Involvement in A Patient with Tuberous Sclerosis. J Urol, 2001, 165:179.
10.S. K. Yip. C. S. Sim and B. S. Tan: Liver metastasis and Local Recurrence after radical Nephrectomy for An Atypical Angiomyolipoma, 2001, 165, 898-899., 百拇医药(唐孝达)
保留肾组织手术包括肿瘤剜除术，肾部分切除。有时肿瘤周围血管极为丰富，术中出血不易控制而被迫切除肾脏。对大的肿瘤术前可考虑作选择性肾动脉造影，了解血供及其走向，有助于保留肾手术的旅行。术中阻断肾动脉亦有利于保留肾手术的施行。
, 百拇医药
参考文献：
1.Arie Belldegrun & Jean B. Dedernion: Renal Tumors, in Campbell’s Urology vol III 7th Edition. Edited by Walsh Petrik and Stammy Vallghan, W. B. Saunders Company, 1998, P. 2883.
2.Steiner MS, Goldman SM, Fishman eK, et al. The National History of AMLs. J. Urol, 1993, 150:1782-1786.
3.Y. M. H., J. M. L., Y. H. L., et al. Renal Angiomyolipoma: Selective Arterial Embolization-Effectiveness and changes in Angiomyogenic Components in Long-term Followup. 1997, 204: 65-70.
, 百拇医药
4.M Jinzaki, A. Tanimoto, Y. Narimatsu, et al. Angiomyolipoma: Imaging Findinjgs in Lesions with Minimal Fat. Radilogy, 1997, 205: 497-502.
5.Lamaitre L, Robert Y, Dubrule F, et al. Renal Angiomyolipoma: growth followup with CT and/or US. Radiology, 1995, 197: 598-602.
6.Oesterling JE, Fishman EK, Goldman SM, et al. The managemetn of renal angiomyolipoma. J, Urol., 1986, 135:1121-1124.
7.Helenon O, Merran S, Paraf F, et al. Unusual fat-containing tumors of the kidney: diagnostic de=ilemma. Radiographics, 1997, 17:129-144.
, http://www.100md.com
8.N. Taniguchi, K. Itoh, S. Nakmura. Differentiation of renal cell Carciuowas from Angimyolipomas by Ultrasonic Frequency Dependent Attenuation. J. Urol, 1997, 157:1242-1245.
9.Kwai-Fong NG and Tse-Ching Chen. Infiltrating Renal Angiomyolipoma into Asending Colocn association with Hepatic Involvement in A Patient with Tuberous Sclerosis. J Urol, 2001, 165:179.
10.S. K. Yip. C. S. Sim and B. S. Tan: Liver metastasis and Local Recurrence after radical Nephrectomy for An Atypical Angiomyolipoma, 2001, 165, 898-899., 百拇医药(唐孝达)