目的:探讨不同手术时机对肾血管平滑肌脂肪瘤(RAML)破裂出血手术治疗效果的影响。
方法:收集2013年6月至2023年2月我院医疗中心收治的31例RAML破裂出血患者的人口学资料及围手术期资料。将出血后7天内的手术定义为短期手术组,出血后7天至6个月的手术被定义为中期手术组,出血后超过6个月的手术被定义为长期手术组。比较3组围手术期相关指标。
结果:本研究收集了31例因RAML破裂出血而接受手术治疗的患者,其中13人是男性,18人是女性,平均年龄(46.2±11.3)岁。短期手术组包括7例患者,中期手术组包括12例患者,长期手术组包括12例患者.就肿瘤直径而言,长期手术组患者明显低于近期手术组[(6.6±2.4)cmvs.(10.0±3.0)cm,P=0.039]。在手术时间上,长期手术组明显短于中期手术组[(157.5±56.8)minvs.(254.8±80.1)min,P=0.006],其他组间差异无统计学意义。就手术过程中估计的失血而言,长期手术组明显低于中期手术组[35(10,100)mLvs.650(300,1200)mL,P<0.001],其他组间差异无统计学意义。在术中输血方面,长期手术组明显低于中期手术组[0(0,0)mLvs.200(0,700)mL,P=0.014],其他组间差异无统计学意义。就术后住院天数而言,长期手术组明显低于中期手术组[5(4,7)dvs.7(6,10)d,P=0.011],其他组间差异无统计学意义。
结论:我们认为对于RAML破裂出血的患者,超过6个月的再手术是一个相对安全的时间范围,术中出血最少。因此,通过保守治疗使血肿系统化后,更建议进行手术治疗。
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.
CONCLUSIONS: 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.