| Objectives:To Analyze the curative effect between surgical and Selective Artery Embolization(SAE)of Renal angiomyolipoma(RAML),and compare the curative effect of different types of RAML with different treatment methods,to analyze and predict the factors that affect the curative effect of SAE,so as to provide reference for the treatment of RAML.Methods:The data of 129 cases of RAML undergoing surgery and SAE were collected in the Department of Urology,The First Affiliated Hospital of Kunming Medical University from January 1,2013 to May 1,2020.The data mainly included general information,preoperative renal score,operation time,intraoperative blood loss,postoperative ambulation time,postoperative hospital stay,dosage of postoperative analgesics and antiemetics,postoperative complications,postoperative recurrence,postoperative secondary treatment and.and all the 129 cases of RAM were followed up and recorded.The cases are divided into the following groups:1.According to whether the tumor ruptured or not,they were divided into two groups:hemorrhage treatment group(n=32)and preventive treatment group(n=97),and According to the treatment method,it is divided into surgical treatment and SAE group.The intraoperative and postoperative efficacy of different treatment methods in hemorrhage treatment group was analyzed.2.The preventive treatment group was divided into three groups according to RENAL score:38 cases with low RENAL score(4-6 points),48 cases with moderate RENAL score(7-9 points)and 11 cases with high RENAL score(10-12 points).The efficacy-related indexes of the three groups were compared with the surgical treatment and SAE group.3.All cases of SAE were divided into two groups according to RECIST grading criteria:significant group(n=26)and insignificant group(n=29),and the factors affecting the efficacy of SAE were analyzed and predicted.Results:1.A total of 32 cases were treated with hemorrhage,of which 14 cases underwent surgical treatment,including 3 cases of open nephrectomy,2 cases of open partial nephrectomy,2 cases of laparoscopic nephrectomy,7 cases of laparoscopic partial nephrectomy,18 cases were treated with SAE.There were 0 cases in the secondary treatment after operation,and 2 cases in the SAE group.There were significant differences in operative time,intraoperative blood loss,postoperative analgesic drug dose,antiemetic drug dose,postoperative hemoglobin level and postoperative complication grade between the surgical treatment group and the SAE group(P<0.05).2.There were 97 cases of preventive treatment,including 38 cases 38 cases in the low RENAL score group,27 cases in surgical treatment,11 cases in SAE treatment;48 cases in the middle RENAL score group,28 cases in surgical treatment,and 20 cases in SAE treatment;11 cases in the high RENAL score group,5 cases in surgical treatment,SAE 6 cases were treated.There were significant statistical differences in operative time,intraoperative blood loss,postoperative time out of bed,postoperative hospitalization date and postoperative analgesic drug dosage between the surgical treatment and SAE in the three RENAL score groups(P<0.05).①in the low RENAL score group,the operation time of the surgical treatment group was 99.07±28.15 minutes,the intraoperative blood loss was 30(20-50)ml,the postoperative bed time was 2(2～3)days,and the postoperative hospital stay was 6(5～7)days,the analgesic dose was 22.5(18.75-30)mg;the operation time of the SAE group was 52.91±7.15 min,the intraoperative blood loss was 15(10-25)ml,and the postoperative time to get out of bed was 1(1～2)days,the postoperative hospital stay was 5(3～5)days,and the analgesic dose was 0(0～10)mg.②in the middle RENAL score group,the operation time of the surgical treatment group was 100(72.5～120)minutes,the intraoperative blood loss was 50(27.5～100)ml,the postoperative bed time was 2(2～2)days,and the postoperative hospital stay was 6(5～7)days,the analgesic dose was 15(0～28.75)mg;the operation time of the SAE group was 55.5(50.75～60)minutes,the intraoperative blood loss was 17.5(11.25～30)ml,and the postoperative time to get out of bed was 1(1～1.75)days,the postoperative hospital stay was 5(4～6)days,and the analgesic dose was 5(0～5)mg.③in the high RENAL score group,the operation time of the surgical treatment group was 111.00±15.97 minutes,the intraoperative blood loss was 60(40～80)ml,the postoperative bed time was 2(2～2.5)days,and the postoperative hospital stay was 7(6～8)days,the analgesic dose was 20(15～35)mg;the operation time of the SAE group was 57.50±18.37minutes,the intraoperative blood loss was 10(10～16.25)ml,and the postoperative time to get out of bed was 1(1～2)days,the postoperative hospital stay was 5.5(3～6)days,and the analgesic dose was 7.5(3.75～11.25)mg.There were 0 cases in the secondary treatment after operation,and 3 cases in the SAE group.3.A total of 55 cases were treated with SAE,The median follow-up time was 20 months,and the mean tumor reduction rate was 29.94%.The curative effect was significant in 26 cases and insignificant in 29 cases.The proportion of tumor enhancement area<25%in preoperative CT or MRI was a predictor of insignificant curative effect.Conclusions:1.For patients with RAML hemorrhage who need intervention,the first choice is SAE.2.For patients with RAML who need preventive treatment:in cases with moderate or low RENAL score,either surgical treatment or SAE treatment can be the first choice.We make the final decision based on the patient’s different physical conditions,treatment needs,and the surgeon’s surgical operation proficiency.For RAML patients with a high RENAL score,SAE is recommended as the preferred treatment.However,more frequent follow-ups are required after SAE.3.The proportion of tumor’s enhancement area in preoperative CT or MRI<25%can predict that the curative effect of selective arterial embolization is not significant.Therefore,it is recommended to consider surgical treatment as the first choice for RAML patients whose preoperative CT or MRI showed tumor’s enhancement area ratio less than 25%. |
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