病例報告: 達文西機器人輔助部分腎臟切除後的巨大假性動脈瘤
何肇晏1、林宜佳1,3、盧大年2、黃一勝1,3, 4
1新光吳火獅紀念醫院 外科部 泌尿科,2放射科,3輔仁大學醫學院,2台北醫學大學泌尿科
Case report: a giant pseudoaneurysm after robotic-assisted laparoscopic partial nephrectomy
Chao-Yen Ho1, Yi-Chia Lin1,3, Ta-Nien Lu2, Thomas I.S. Hwang1,3,4
1Division of Urology, Department of Surgery, 2Department of Radiology, Shin Kong WHS Memorial Hospital, Taipei, Taiwan, 3School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, 4Department of Urology, Taipei Medical University
 
Abstract:
Partial nephrectomy (PN) is the standard treatment option for patients with small renal mass, such as clinical T1a to T1b renal tumors. Compared with radical nephrectomy, PN is a more complicated procedure with involvement of both vascular and collecting systems, and complications can occur. The incidence of renal artery pseudoaneurysm(RAP) after PN is between 0.4% and 2%. Minimally invasive procedures, such as laparoscopic or robotic-assisted approaches have a higher incidence of RAP when compared with open PN.
Here we present a 63-year-old male with incidentally finding of a right renal tumor, clinical stage of T1bN0M0. He underwent a robot-assisted laparoscopic partial nephrectomy (RAPN). The patient tolerated the procedure well and was discharged uneventfully. The pathology report showed a papillary renal cell carcinoma, pT1bNxMx, Fuhrman grade II, with a negative surgical margin. However, the patient presented to ER with intermittent gross hematuria aggravated since one month after the operation. Contrast enhanced computerized tomography (CT) scan demonstrated a large pseudoaneurysm of 5 × 4.4 × 3.9 cm in size over the posterior part of the right kidney at the incision site. Transfemoral renal angiography performed by a radiologist demonstrated a huge pseudoaneurysm from the posterior branches of the right renal artery. Selective embolization was performed with coils, glue and gel-foam cubes. The patient tolerated the procedure well and was discharged uneventfully.
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    TUA秘書處1
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    台灣泌尿科醫學會
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    非討論式海報
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    2015-05-27 14:03:00
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    2015-05-27 14:04:40
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