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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (2): 326-331. doi: 10.19723/j.issn.1671-167X.2024.02.020

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Discussion on the surgical timing of rupture and hemorrhage of renal angiomyolipoma

Kewei CHEN,Shaohui DENG,Zhuo LIU,Hongxian ZHANG,Lulin MA,Shudong ZHANG*()   

  1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
  • Received:2023-03-27 Online:2024-04-18 Published:2024-04-10
  • Contact: Shudong ZHANG E-mail:zhangshudong@bjmu.edu.cn

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Abstract:

Objective: To investigate the effect of different surgical timing on the surgical treatment of renal angiomyolipoma (RAML) with rupture and hemorrhage. Methods: The demographic data and perioperative data of 31 patients with rupture and hemorrhage of RAML admitted to our medical center from June 2013 to February 2023 were collected. The surgery within 7 days after hemorrhage was defined as a short-term surgery group, the surgery between 7 days and 6 months after hemorrhage was defined as a medium-term surgery group, and the surgery beyond 6 months after hemorrhage was defined as a long-term surgery group. The perioperative related indicators among the three groups were compared. Results: This study collected 31 patients who underwent surgical treatment for RAML rupture and hemorrhage, of whom 13 were males and 18 were females, with an average age of (46.2±11.3) years. The short-term surgery group included 7 patients, the medium-term surgery group included 12 patients and the long-term surgery group included 12 patients. In terms of tumor diameter, the patients in the long-term surgery group were significantly lower than those in the recent surgery group [(6.6±2.4) cm vs. (10.0±3.0) cm, P=0.039]. In terms of operation time, the long-term surgery group was significantly shorter than the mid-term surgery group [(157.5±56.8) min vs. (254.8±80.1) min, P=0.006], and there was no significant difference between other groups. In terms of estimated blood loss during surgery, the long-term surgery group was significantly lower than the mid-term surgery group [35 (10, 100) mL vs. 650 (300, 1 200) mL, P < 0.001], and there was no significant difference between other groups. In terms of intraoperative blood transfusion, the long-term surgery group was significantly lower than the mid-term surgery group [0 (0, 0) mL vs. 200 (0, 700) mL, P=0.014], and there was no significant difference between other groups. In terms of postoperative hospitalization days, the long-term surgery group was significantly lower than the mid-term surgery group [5 (4, 7) d vs. 7 (6, 10) d, P=0.011], and there was no significant difference between other groups. Conclusion: We believe that for patients with RAML rupture and hemorrhage, reoperation for more than 6 months is a relatively safe time range, with minimal intraoperative bleeding. Therefore, it is more recommended to undergo surgical treatment after the hematoma is systematized through conservative treatment.

Key words: Renal angiomyolipoma, Rupture and hemorrhage, Nephron-sparing surgery, Operation time, Intraoperative hemorrhage

CLC Number: 

  • R737.11

Figure 1

Tumor diameters among three groups of patients ns, not statistically. * P < 0.05."

Table 1

Demographic data of patients of renal angiomyolipoma rupture"

Items Group of surgery within 14 days (n=7) Group of surgery between 7 days and 6 months (n=12) Group of surgery over 6 months (n=12) F/χ2 P
Age/years, $\bar x \pm s$ 44.0±10.4 44.0±10.4 49.7±12.6 0.921 0.409
Gender, n(%) 0.003 0.998
  Male 3 (42.9) 5 (41.7) 5 (41.7)
  Female 4 (57.1) 7 (58.3) 7 (58.3)
Height/cm, $\bar x \pm s$ 166.0±7.6 165.8±9.2 165.8±7.7 0.002 0.997
Weight/kg, $\bar x \pm s$ 65.9±15.2 71.3±9.2 68.3±7.8 0.631 0.540
BMI/(kg/m2), $\bar x \pm s$ 23.6±3.5 25.9±2.8 24.8±1.7 1.748 0.193
Underlying disease, n(%) 2 (28.6) 3 (25.0) 5 (41.7) 0.819 0.664
Clinical symptom, n(%)
  Back pain 7 (100.0) 10 (83.3) 6 (50.0) 8.148 0.017
  Hematuria 1 (14.3) 2 (16.7) 1 (8.3) 0.384 0.825
  Fever 3 (42.9) 1 (8.3) 1 (8.3) 4.243 0.120
  Renal cyst 0 (0.0) 3 (25.0) 5 (41.7) 4.105 0.130
Max diameter of RAML/cm, $\bar x \pm s$ 10.0±3.0 8.7±2.9 6.6±2.4 3.846 0.033
Side, n(%) 0.444 0.801
  Left 4 (57.1) 6 (50.0) 5 (41.7)
  Right 3 (42.9) 6 (50.0) 7 (58.3)
Multiple site, n(%) 5 (71.4) 6 (50.0) 4 (33.3) 2.589 0.274
Polar position, n(%) 3.125 0.537
  Upper pole 2 (28.6) 5 (41.7) 6 (50.0)
  Middle pole 0 (0.0) 2 (16.7) 2 (16.7)
  Lower pole 5 (71.4) 5 (41.7) 4 (33.3)

Figure 2

Operation time among three groups of patients ns, not statistically."

Figure 3

Estimated blood loss among three groups of patients"

Figure 4

Postoperative hospitalization time among three groups of patients"

Table 2

Perioperative information of patients of renal angiomyolipoma rupture"

Items Group of surgery within 7 d (n=7) Group of surgery between 7 d and 6 months (n=12) Group of surgery over 6 months (n=12) F/χ2 P
Surgical approach, n(%) 5.424 0.247
  Laparoscopy 4 (57.1) 7 (58.3) 10 (83.3)
  Open 2 (28.6) 5 (41.7) 2 (16.7)
  Robot-assisted laparoscopy 1 (14.3) 0 (0.0) 0 (0.0)
Operation time/min, $\bar x \pm s$ 197.7±73.4 254.8±80.1 157.5±56.8 5.794 0.008
Warm ischemia time/min, $\bar x \pm s$ 18.9±12.5 22.3±13.6 16.2±7.7 0.661 0.526
Estimated blood loss/mL, M(P25, P75) 400 (100, 600) 650 (350, 1 200) 35 (10, 100) 13.340 0.001
Blood transfusion rate, n(%) 2 (28.6) 6 (50.0) 0 (0.0) 7.870 0.020
Blood transfusion volume/mL, M(P25, P75) 0 (0, 400) 200 (0, 700) 0 (0, 0) 7.904 0.019
Nephrectomy rate, n(%) 0 (0.0) 2(16.7) 2 (16.7) 1.340 0.510
Preoperative serum creatine/(μmoI/L), $\bar x \pm s$ 61.3±13.2 78.5±18.0 76.3±12.6 3.169 0.058
Postoperative serum creatine/(μmoI/L), $\bar x \pm s$ 77.3±21.3 85.8±33.9 72.6±12.1 0.883 0.424
Serum creatine changes/(μmoI/L), $\bar x \pm s$ 16.0±11.1 7.3±25.2 -3.8±10.3 2.881 0.073
ASA, n(%) 4.722 0.320
  1 2 (28.6) 5 (41.7) 1 (8.3)
  2 5 (71.4) 7 (58.3) 10 (83.3)
  3 0 (0.0) 0 (0.0) 1 (8.3)
Postoperative hospitalization time/d, M(P25, P75) 5 (5, 6) 6.5 (6, 9.5) 5 (4, 7) 9.021 0.011
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