腹腔镜保留肾单位手术治疗巨大肾血管平滑肌脂肪瘤的疗效与安全性

doi:10.19723/j.issn.1671-167X.2026.04.025

摘要/Abstract

摘要：

目的: 巨大肾血管平滑肌脂肪瘤的病例因肿瘤体积大、易破裂出血等因素，手术难度及风险较高。本文旨在探讨巨大肾血管平滑肌脂肪瘤行腹腔镜保留肾单位手术的有效性和安全性。方法: 回顾性分析2012年1月至2025年9月于北京大学第三医院接受保留肾单位手术治疗的45例巨大(≥8 cm)肾血管平滑肌脂肪瘤患者的临床资料，男11例，女34例，年龄20~74岁，平均肿瘤最大直径(10.3±2.2) cm (8.0~15.4 cm)。所有患者均行腹腔镜保留肾单位手术，入路包括经后腹腔(32例)和经腹腔(13例)。病理分类参考2022年世界卫生组织的标准。主要观察指标包括手术时长、肾动脉阻断时长、术后住院时长、手术并发症、术中出血量等。结果: 45例患者的手术均顺利完成，均完整切除瘤体并实现肾单位保留，其中5例中转开放手术。手术时长(180.6±55.7) min (86~312 min)，肾动脉阻断时长(21.9±9.8) min (6~40 min)，术后住院时间(6.2±2.6) d (3~14 d)，术后拔管时间(5.1±2.2) d (2~14 d)。术后组织病理均证实为肾血管平滑肌脂肪瘤且切缘均为阴性。1例术后出现肺部感染，1例术后出现肾功能不全。术后患者随访3~43个月，无肿瘤复发。结论: 对于经过筛选的巨大肾血管平滑肌脂肪瘤病例施行保留肾单位手术，可在完整切除肿瘤、保证切缘阴性、避免并发症的基础上，有效保留肾功能。

关键词: 肾血管平滑肌脂肪瘤, 保留肾单位手术, 腹腔镜检查, 治疗结果

Abstract:

Objective: Giant renal angiomyolipoma (RAML), typically defined as having a maximum diameter of ≥8 cm, presents formidable surgical challenges and heightened clinical risks. These challenges primarily stem from the tumor's extensive volume, highly enriched but fragile vascularization, and significant susceptibility to spontaneous rupture and life-threatening hemorrhage. This study aims to comprehensively evaluate the clinical effectiveness and safety of laparoscopic nephron-sparing surgery (NSS) for the management of these complex giant lesions. Methods: A retrospective analysis was performed on 45 patients with giant (≥8 cm) RAML who received NSS at Peking University Third Hospital between January 2012 and September 2025. The cohort comprised 11 males and 34 females with a mean age of (40.9±14.1) years and a mean body mass index (BMI) of (23.7±4.0) kg/m². Preoperatively, 5 patients had a history of spontaneous hemorrhage, and 2 were pregnant. The mean maximum tumor diameter was (10.3±2.2) cm, ranging from 8.0 to 15.4 cm. Surgical procedures included standard laparoscopy (39 cases) and Da Vinci robotic-assisted laparoscopy (6 cases), utilizing either a retro-peritoneal approach (32 cases, 71.1%) or a transperitoneal approach (13 cases, 28.9%). Pathological diagnosis and differentiation were conducted in strict accordance with the 2022 World Health Organization (WHO) classification of tumors. Key outcome measures included operative time, warm ischemia time, estimated blood loss, postoperative complications, and length of postoperative hospital stay. Results: All the 45 operations were successfully completed with complete tumor resection and nephron preservation, although 5 cases required conversion to open surgery due to severe adhesions or bleeding. The operative time was (180.6±55.7) min (range: 86-312 min), the warm ischemia time was (21.9±9.8) min (range: 6-40 min); 36 cases had a warm ischemia time ≤30 min, while a zero-ischemia technique was employed in 3 cases. The postoperative hospital stay was (6.2±2.6) days (range: 3-14 days), and the time to drainage tube removal was (5.1±2.2) days (range: 2-14 days). Postoperative patho-logy confirmed RAML in all cases, and all surgical margins were negative. Postoperative complications included one case of pulmonary infection and one case of renal insufficiency. During a follow-up of 3 to 43 months, no tumor recurrence or significant loss of renal function was documented. Conclusion: NSS for selected patients with giant RAML is effective in preserving renal function while ensuring complete tumor resection, negative margins, and avoiding short-term and long-term complications. Robotic-assisted systems, in particular, offer distinct advantages in complex wound reconstruction and the reduction of surgical complications.

Key words: Renal angiomyolipoma, Nephron-sparing surgery, Laparoscopy, Treatment outcome

中图分类号:

R737.11

段佩辰, 虞乐, 张帆, 侯小飞, 王国良, 郝一昌, 张树栋. 腹腔镜保留肾单位手术治疗巨大肾血管平滑肌脂肪瘤的疗效与安全性[J]. 北京大学学报（医学版）, 2026, 58(4): 860-864.

Peichen DUAN, Le YU, Fan ZHANG, Xiaofei HOU, Guoliang WANG, Yichang HAO, Shudong ZHANG. Efficacy and safety of laparoscopic nephron-sparing surgery for giant renal angio-myolipoma[J]. Journal of Peking University (Health Sciences), 2026, 58(4): 860-864.

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参考文献 20

1	Nason GJ , Morris J , Bhatt JR , et al. Natural history of renal angiomyolipoma favors surveillance as an initial approach[J]. Eur Urol Focus, 2021, 7 (3): 582- 588. doi: 10.1016/j.euf.2020.06.004
2	Jorgenson LC , Navin PJ , Adamo D , et al. Imaging and nonsurgical management of renal masses[J]. RadioGraphics, 2025, 45 (1): e240093. doi: 10.1148/rg.240093
3	陈克伟, 邓绍晖, 刘茁, 等. 肾血管平滑肌脂肪瘤破裂出血的手术时机[J]. 北京大学学报(医学版), 2024, 56 (2): 326- 331. doi: 10.19723/j.issn.1671-167X.2024.02.020
4	Fernández-Pello S , Hora M , Kuusk T , et al. Management of sporadic renal angiomyolipomas: A systematic review of available evidence to guide recommendations from the European association of urology renal cell carcinoma guidelines panel[J]. Eur Urol Oncol, 2020, 3 (1): 57- 72. doi: 10.1016/j.euo.2019.04.005
5	Li Z , Yang L , Yang H , et al. Comparison of superselective renal artery embolization versus retroperitoneal laparoscopic partial nephrectomy in ruptured hemorrhagic renal angiomyolipoma: A single-center study[J]. Diseases, 2024, 12 (9): 218. doi: 10.3390/diseases12090218
6	Tang S , Song Y , Liu Y , et al. Robot-assisted and embolization-assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal angiomyolipoma: A systematic review and meta-analysis[J]. J Rob Surg, 2025, 20 (1): 79. doi: 10.1007/s11701-025-03026-5
7	Moch H , Amin MB , Berney DM , et al. The 2022 World Health Organization classification of tumours of the urinary system and male genital organs: Part A: Renal, penile, and testicular tumours[J]. Eur Urol, 2022, 82 (5): 458- 468. doi: 10.1016/j.eururo.2022.06.016
8	中国抗癌协会泌尿男生殖系肿瘤专业委员会结节性硬化协作组. 结节性硬化症相关肾血管平滑肌脂肪瘤诊疗与管理专家共识[J]. 中国癌症杂志, 2020, 30 (1): 70- 78.
9	Northrup H , Aronow ME , Bebin EM , et al. Updated international tuberous sclerosis complex diagnostic criteria and surveillance and management recommendations[J]. Pediatr Neurol, 2021, 123, 50- 66. doi: 10.1016/j.pediatrneurol.2021.07.011
10	Kobayashi M , Yokoyama M , Yuki H , et al. Natural history and management of ultrasound-detected small renal angiomyolipoma[J]. J Med Ultrasound, 2024, 32 (2): 154- 160. doi: 10.4103/jmu.jmu_73_23
11	Kuusk T , Biancari F , Lane B , et al. Treatment of renal angiomyolipoma: Pooled analysis of individual patient data[J]. BMC Urol, 2015, 15 (1): 123. doi: 10.1186/s12894-015-0118-2
12	Lee KH , Tsai HY , Kao YT , et al. Clinical behavior and management of three types of renal angiomyolipomas[J]. J Formos Med Assoc, 2019, 118 (1): 162- 169. doi: 10.1016/j.jfma.2018.02.012
13	邱敏, 田晓军, 卢剑, 等. 后腹腔镜肾部分切除术治疗巨大(≥ 8 cm)肾错构瘤的技巧探讨[J]. 中国微创外科杂志, 2017, 17 (10): 905- 908.
14	熊芸强, 刘霄强, 陈路遥, 等. 机器人辅助腹腔镜肾部分切除术治疗巨大肾血管平滑肌脂肪瘤的安全性及有效性[J]. 现代泌尿外科杂志, 2021, 26 (11): 927- 929.
15	Nasim A , Azam A , Mufti AF , et al. Giant renal angiomyolipoma (RAML): A case report and literature review[J]. J Pak Med Assoc, 2025, 75 (7): 1131- 1134. doi: 10.47391/JPMA.21576
16	Zhou X , Chen Q , Xiong Z , et al. Giant renal angiomyolipoma unmasks underlying lymphangioleiomyomatosis: A case report and literature review[J]. Front Med (Lausanne), 2025, 12, 1610464.
17	Su R , Huang T , Gu L , et al. Neoadjuvant everolimus in renal angiomyolipoma with or without tuberous sclerosis complex: Results from a multicenter, retrospective study[J]. Cancer Med, 2024, 13 (17): e70181. doi: 10.1002/cam4.70181
18	Yang Z , Wang F , Lin D , et al. Modified laparoscopic nephron-sparing surgery for large renal hilar angiomyolipoma: Dual-center experience[J]. Front Surg, 2022, 9, 901033. doi: 10.3389/fsurg.2022.901033
19	Zhang Y , Zhang Z , Li F , et al. Management of renal sinus angiomyolipoma: Modified robotic nephron-sparing surgery in a single center[J]. BMC Urol, 2024, 24 (1): 103. doi: 10.1186/s12894-024-01492-x
20	Xue Y , Zhang G , Zhang H , et al. Off-clamp robot-assisted nephron-sparing surgery is associated with less operative time and potential for vascular complication in the treatment of renal angiomyolipoma > 4cm: A comparative study[J]. BMC Urol, 2025, 25 (1): 149. doi: 10.1186/s12894-025-01836-1

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Characteristic	Value
Age/years	40.9±14.1
Gender
Male	11 (24.4)
Female	34 (75.6)
Body mass index/(kg/m²)	23.7±4.0
Tumor diameter/cm	10.3±2.2
Surgical side
Left	23 (51.1)
Right	22 (48.9)
Preoperative imaging suggestive of contralateral RAML
No	38 (84.4)
Yes	7 (15.6)
Preoperative estimated residual renal volume/mL	85.4±23.6
Surgical method
Laparoscopic	39 (86.7)
Robotic	6 (13.3)
Surgical approach
Transperitoneal	13 (28.9)
Retroperitoneal	32 (71.1)
Operative time/min	180.6±55.7
Renal artery clamping time/min	21.9±9.8
Estimated blood loss/mL	100 (10, 1 300)
Postoperative hospital stay/d	6.2±2.6
Time to drainage removal/d	5.1±2.2