巨大血管平滑肌脂肪瘤逕行部分腎臟切除術前是否有栓塞之比較
陳經國，黃冠華1，李高漢，賴韋宏2
奇美醫學中心 外科部 泌尿外科 ，1泌尿腫瘤科；
2戴德森醫療財團法人嘉義基督教醫院 外科部 泌尿科
Comparison of large renal angiomyolipoma with or without Transcatheter arterial embolization before partial nephrectomy
Kengkok Tan, Steven Kuan-Hua Huang1, Kau Han Lee, Wei-Hong Lai2
Division of Urology, Department of Surgery, Division of Uro-Oncology1,
Chi Mei Medical Center, Tainan, Taiwan;
Division of Urology2, Department of Surgery,
Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
Purpose
Angiomyolipoma(AML) is a benign neoplasm composed of varying admixtures of blood vessels, smooth muscle cells, and adipose tissue. However, it often leads to spontaneous hemorrhagic, pain or hematuria if large size. Invasive interventions including embolization, nephron-sparing surgery, or even nephrectomy were suggested for larger tumor. Due to increase risk of bleeding in larger tumor during operation, preoperation transcatheter arterial embolization (TAE) in larger tumor maybe can make the surgery more smoothly and decrease intra-operation blood loss. Hence, we are here to share our hospital’s clinical experience.
Materials and Methods
From March 2012 to November 2015, 13 cases of large AML (tumor size ≧7cm) underwent the nephron-sparing surgery in Chi Mei Medical Center. Preoperation transcatheter arterial embolization was performed in 6 cases (TAE group) and the other 7 cases are not (Non-TAE group). Patient demographics, tumor characteristics, intraoperative, and postoperative data including tumor size, warm ischemia time, and estimated blood loss (EBL) were analyzed and compared between these two group.
Results
From March 2012 to September 2015, there were 5 male and 8 female patients met the inclusion criteria. The mean age was 46-year-old. Most of them have the chief complaint of flank pain (61.5%), because of tumor mass effect or rupture. The average tumor size was 11.7cm (7-22) and the average nephrometry score was 8. In the TAE group, mean warm ischemia time (WIT) was 5 min 02 sec and Non-TAE group was 11 min 32 sec. Mean blood loss was 1650ml (300-4000) in TAE group and 1900ml (50~7200) in Non-TAE group. The mean post operation length of l stay was 5 days in TAE group and 6.4 days in Non-TAE group. In Non-TAE group, there were 3 patient (43%) showed residual tumor during post op follow up imaging study and only 1 patient (16%) showed residual tumor in TAE group.
Conclusions
In large AML case, TAE before partial nephrectomy had shorter WIT, decrease intra-operation blood loss, shorter length of stay and fewer residual tumor than those did not performed TAE.