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.
目的: 探讨不同的手术时机对肾血管平滑肌脂肪瘤(renal angiomyolipoma，RAML)破裂出血患者手术治疗效果的影响。
方法: 选择北京大学第三医院泌尿外科2013年6月至2023年2月收治的31例RAML破裂出血患者的病例资料进行回顾性分析，记录患者人口学和围手术期资料，将出血后小于7 d手术定义为近期手术组，出血后7 d至6个月手术定义为中期手术组，出血后超过6个月手术定义为远期手术组，比较组间的围手术期相关指标。
结果: 收集到行RAML破裂出血手术治疗的患者共31例，其中男性13例，女性18例，平均年龄(46.2±11.3)岁。近期手术组7例，中期手术组12例，远期手术组12例。肿瘤直径方面，远期手术组患者显著低于近期手术组[(6.6±2.4) cm vs. (10.0±3.0) cm, P=0.039]；手术时间方面，远期手术组显著低于中期手术组[(157.5±56.8) min vs. (254.8±80.1) min, P=0.006]，其余组间比较差异无统计学意义；出血量方面，远期手术组低于中期手术组[35 (10，100) mL vs. 650 (300，1 200) mL，P＜0.001]，其余组间比较差异无统计学意义；术中输血量方面，远期手术组显著低于中期手术组[ 0 (0，0) mL vs. 200 (0，700) mL, P=0.014]，其余组间比较差异无统计学意义；术后住院天数方面，远期手术组显著低于中期手术组[5 (4, 7) d vs. 7 (6, 10) d，P=0.011]，其余组间比较差异无统计学意义。
结论: 对于RAML破裂出血的患者，6个月以上再行手术是一个相对安全的时间，手术时间相对最短，术中出血量相对最少，因此更推荐待保守治疗血肿机化后再进行手术治疗。
Keywords: Intraoperative hemorrhage; Nephron-sparing surgery; Operation time; Renal angiomyolipoma; Rupture and hemorrhage.