1996 Volume 87 Issue 10 Pages 1151-1157
(Background) Nephron-sparing surgery is ideal in the treatment of renal angiomyolipoma (AML). But, in fact, ocasional cases are found in post-ruptured AML and/or in bilateral multiple AMLs, that is seen in tuberous sclerosis. And we cannot perform nephron sparing surgery so easily. We proposed the treatment selection in such complicated AML.
(Methods) We experienced 10 cases (12 kidneys) for about ten years, and studied our treatment selection and prognosis on each cases retrospectively.
(Results) Of the 5 kidneys with AML less than 4cm in diameter, 4 have not encountered with rupture. Of the 7 kidneys with AML more than 4cm in diameter, 4 kidneys had rupture. Of the 3 kidneys unruptured AML more than 4cm in diameter, 2 kidneys were treated by enucleation and we performed preventive embolization for rupture in residual one kidney. The patients was suffered from tuberuos sclerosis, and she had bilateral multiple AMLs. Of the 4 kidneys with ruptured AML, 2 kidneys were treated by enucleation, and the other 2 kidneys were entirely resected. We succeeded enucleation in 2 of 4 kidneys with ruptured complicated AML. In those cases, we did long term watching after rupture and in-situ perfusion technique at the operation.
(Conclusions) Active treatment of AML, that is more than 4cm in diameter, migth be recommended. Because most of those will be ruptured. The ideal treatment, nephron-sparing surgery is difficult in complicated situation, such as after rupture and bilateral multiple AMLs. In our opinion, the point of success of nephron-sparing surgery migth be long term watching after rupture and in-situ perfusion technique at the operation.
