收稿日期：2023-11-24 接受日期：2023-11-24 出版日期：2023-11-24 发布日期：2023-11-24
通讯作者： 罗广承,主任医师,教授,厦门大学，医学院，厦门大学附属中山医院 泌尿外科，福建 厦门；福建医科大学临床医学部，福州
作者简介： 李张群 . 罗广承,男,厦门大学，医学院，厦门大学附属中山医院 泌尿外科，福建 厦门；福建医科大学临床医学部，福州,主任医师,教授,前列腺疾病诊治厦门市医学优势亚专科负责人；厦门大学医学院临床教授委员会委员；厦门大学、福建医科大学研究生导师；福建省医学会泌尿外科分会学术委员，福建省抗癌协会泌尿男生殖系肿瘤分会学术委员；厦门市医师协会泌尿外科分会副会长等 . 黄定平 . 王新君,男,厦门大学，医学院，厦门大学附属中山医院 泌尿外科，福建 厦门 361000；福建医科大学临床医学部，福州 350000,副主任医师,厦门大学、福建医科大学硕士研究生导师。福建省抗癌协会泌尿男生殖系肿瘤专委会青年委员、厦门市医师协会泌尿外科分会青年委员等。 .
基金资助：，项目负责人： 罗广承
中图分类号：R737.11
文献标识码：A
文章编号：1674-7410(2023)04-0073-06
DOI：10.20020/j.CNKI.1674-7410.2023.04.14
摘要：汇报 1 例肾血管平滑肌脂肪瘤 （renal angiomyolipoma，RAML） 伴静脉瘤栓年轻女性患者的诊断与治 疗，并复习文献，重点探讨预防瘤栓脱落方法及保留肾单位手术的可行性。该患者尝试行机器人辅助腹腔镜下静 脉取栓术+肾部分切除术，因取净瘤栓困难，血流阻断时间过长改行肾切除术。病理证实为 RAML伴静脉瘤栓。 RAML合并静脉瘤栓具有潜在的瘤栓脱落、肺动脉栓塞等高死亡风险。术前腔静脉滤器置入联合肾动脉栓塞可以 尽可能地降低瘤栓脱落风险。保留肾单位治疗的手术方式具有挑战性，但是已经有成功案例，值得尝试。
图 1 肾脏增强 CT
图 2 肾脏增强 CT 冠状位
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肾血管平滑肌脂肪瘤 （renal angiomyolipoma， RAML） 又称肾错构瘤，是肾脏最常见的良性肿瘤， 主要由不同比例的脂肪组织、异常增生的血管和平滑 肌细胞构成，在人群中的发病率约占 0.3%~3%[1] 。 RAML 并肾静脉及下腔静脉瘤栓者罕见，文献报告 较少。目前仍缺乏对 RAML 并静脉瘤栓诊疗策略的 系统报道，本文通过回顾厦门大学附属中山医院近 期收治 RAML 并静脉瘤栓患者 1 例，并结合查阅复 习国内外相关文献，以期提高对该疾病的认识及临床诊疗水平。
1 资料与方法
1.1 临床资料
1.2 治疗方法
2 结果
3 讨论
3.1 RAML 并静脉瘤栓的临床特点
3.2 RAML 并静脉瘤栓的诊断
3.3 RAML并静脉瘤栓的治疗
3.3.1 根治性肾切除术+静脉瘤栓取出术
3.3.2 肾部分切除术+静脉瘤栓取出术
3.3.3 如何预防瘤栓脱落
3.4 预后
见全文
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